Investigation of Sex Differences in Physical Activity and its Relationships with Stress After Myocardial Infarction Open Access
Suvada, Kara (Spring 2026)
Abstract
Introduction: Physical activity following myocardial infarction (MI) improves cardiovascular outcomes and is associated with decreased early mortality. However, adherence to physical activity (PA) guidelines in the U.S. population is low and is likely even lower among adults with cardiac disease burden. This adherence gap is particularly concerning for adults with early-onset cardiovascular disease (<60 years old), as they may face decades of cardiovascular risk management. Furthermore, there are sex disparities in post-MI outcomes among this population, as women face higher rates of post-MI depression and stress, have lower participation rates in cardiac rehabilitation, higher rates of early mortality, and differences in pathophysiology (e.g., microvascular dysfunction). Psychosocial stress is a modifiable barrier to daily PA engagement and may help explain the lower participation of women in this important secondary prevention modality. Additionally, sex differences in stress-related autonomic pathophysiology, which if associated with ability and willingness to participate in PA, may also reveal further explanation.
Goal: The overarching goal of this dissertation work was to examine sex differences in the determinants and distribution of PA in addition to the relationship between psychological stress and stress-related autonomic physiological variables and PA. To achieve this, we examined a cohort of women and men under 61 years old who had recently experienced a myocardial infarction (heart attack) from the second and third waves of the Myocardial Infarction and Mental Stress Study (MIMS2 and MIMS3).
Aim 1A: We examined the relationship between sex and self-reported leisure PA. Women reported less leisure physical activity than men. Additionally, we observed an interaction between sex and race: Black women had the lowest amount of self-reported PA compared to the other three sex-race groups (non-Black women, Black men, and non-Black men). In a relative importance analysis of factors influencing PA, the factors with highest relative importance were depression in Black women, education in Black men and non-Black women, and body mass index in non-Black men.
Aim 1B: In the MIMS3 subgroup, who wore wrist accelerometers for one week, we investigated actigraphy-derived PA patterns, factors influencing low PA, and sex differences. Both sexes were largely sedentary, and women had higher total average daily PA compared to men. The PA in both sexes was predominantly light, and neither sex performed significant moderate or high PA during monitoring. Self-reported functional capacity (e.g., climbing a flight of stairs) was the most influential factor of low PA for both sexes.
Aim 2: We evaluated the relationship between daily psychological factors and actigraphy-derived PA using participant data from MIMS3 and further evaluated for interaction by sex. Our primary exposures were daily stress and real-time negative self-reported mood measured by ecological momentary assessments. Our primary outcome was composite light, moderate, or vigorous PA during the day. Using lagged regression techniques, we found that, in women only, negative mood was associated with significantly lower (best fit lag) PA 24-hours later; the mood-sex interaction was also statistically significant. We did not find any significant associations between self-report daily stressful events and PA in either sex.
Aim 3: We investigated the relationship between stress-related autonomic physiological variables and actigraphy-derived PA using participant data from MIMS3 and further examined for interaction by sex. Our primary exposures were autonomic function, measured by high-frequency heart rate variability (HF-HRV), deceleration capacity (DC), and low-frequency heart rate variability (LF-HRV). Our primary outcome was composite light, moderate, or vigorous PA during the day. Using lagged regression techniques, we found that lower LF-HRV was associated with significantly lower PA 48-hours later in the whole cohort. No associations were found with the other HRV metrics and PA at either 24 or 48-hour lags. We did not find any significant sex interactions.
Conclusions: Our findings have important implications on sex-specific approaches to PA promotion, suggesting that psychological and physiological factors are potentially relevant mechanisms that drive PA behaviors. Notable sex differences included less self-reported leisure PA in women, greater light PA in women, and a greater impact of self-reported negative mood on objective PA in women than men. Autonomic dysfunction also may play an important role in PA with 48-hour lag in both sexes. In summary, these findings support the need for future research that examines the role of biobehavioral strategies that integrate stress reduction and PA promotion together, especially in women.
Table of Contents
Chapter 1: Overview.. 8
Chapter 2: Association of Sex and Race with Self-reported Leisure Physical Activity Among Younger Persons After a Myocardial Infarction. 11
Chapter 3: Sex Differences in Actigraphy-Measured Physical Activity Among Young Survivors of Acute Myocardial Infarction. 34
Chapter 4: Sex differences in previous psychosocial stress and mood and next-day physical activity among young survivors of acute myocardial infarction. 53
Chapter 5: Heart rate variability predicts next-day physical activity among younger survivors of acute myocardial infarction. 80
Chapter 6: Potential Public Health Impact & Future Research Directions. 104
About this Dissertation
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Investigation of Sex Differences in Physical Activity and its Relationships with Stress After Myocardial Infarction () | 2026-04-17 17:25:42 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|